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Photographic 

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CIHM/ICMH 

Microfiche 

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Collection  de 
microfiches. 


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modification  dans  la  m^thode  normale  de  'ilmage 
sent  indiqu^s  ci-dessous. 


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Coloured  covers/ 
Couverture  de  couieur 


□    Covers  damaged/ 
Couv<^rture  endommagde 

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I    ^  I    Cover  title  missing/ 

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£ncre  de  couieur  (i.e.  autre  que  bieue  ou  noire) 

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D 
D 


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Bound  with  other  material/ 
Reii^  avec  d'autres  documents 


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shall  contain  the  symbol  —^(meaning  "CON- 
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Lea  axemplairaa  originaux  dont  la  couvarture  an 
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emprejnte. 

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symbole  V  signifie  "FIN". 


Mapa,  platea,  charts,  etc..  may  be  filmed  at 
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entirely  included  in  one  aiMiposL-ra  are  filmed 
beginning  In  the  upper  le/t  hand  comer,  left  to 
right  and  top  to  bottom,  aa  many  framea  aa 
required.  The  following  diagrama  illustrate  the 
method: 


Laa  cartaa,  planchaa.  tableaux,  ate,  pauvent  dtra 
filmte  it  dee  taux  da  rMuetion  diffirants. 
Lorsqua  la  document  eat  trop  grand  pour  dtra 
raproduit  en  un  saul  cliche,  il  est  film^  d  partir 
da  I'angle  supiriaur  gaucne,  da  gauche  d  droite, 
et  de  haut  en  baa,  an  prenant  le  nombre 
d'Imagea  nicassaira.  Las  diagrammea  suivants 
illustrent  la  m^thoda 


1 

2 

3 

1 

2 

3 

4 

5 

6 

HYPERKERATQ- 
'"MYCOSI.S 


OT  THB 


PHARYNX 


BY 


J^N 


Dr.  Charles  A.  WILSON-PREVOST. 

Graduate  of  the  University  of  Paris;  Late  Extern  of  the  Hospitals  of 
Paris;  Membre  Correspondant  do  la  Societe  Anatomique  de 
Paris;  Member  of  the  Physicians'  Mutual  Aid  Asso- 
ciation of  New  York;  Surgeon  to  the  French 
Hospital. 


('  0  0 


H  Y  PER  KER  ATO- 
MIC OS  IS 


OF  Tin: 


PHARYNX. 


BT 


Dr.  Charles  A.  WILSON-PRHVOST. 

Graduate  of  the  Iniversity  of  Paris;  Late  Extern  of  tl-e  Hospitals  of 
Pans;  Membre  Correspondant  de  la  Societe  Anatomicme.de 
Pans:  riembeiof  the  Physicians'  Mutual  Aid  Asso- 
ciation of  .New  York;  Surgeon  to  the  l-'rench 
Hospital. 


i 


DAMJlliY,  CUNX: 

DANliiriiV    AIkdrai,   PlUNTJNG   Co.MI'ANV. 

I  SOS 


/ 


I 


A  MmNSIEUK  LK  PUOFKSSKlll 

n.  B.  St.  john-Roosa. 

:'HO.''E8SOi{  .,y  LdrifcJAr^KM  Ot    11. f:  KVK  AND  EAIl  IN  TIIK  NK\V  VoltK  I'O.ST- 

UUAOUATK  VrDICAT.  £711001   AN')   >r0SPIT.vL;   StIUOEON  TO  TII{:  MAN- 

H.'.TlviN  Ei'E  AT  n  KAli'lOStMT.'.T.:  *'-^UMKI{r-Y  IM{OFf:SSOU  OF  DIS- 

|:A!-K^  UF     rui-   FYE    in    the    i  NlVKi-.SITV    OF    THE  CrXY   OF 

NKV  VORK    'UM.   TlEb.-Ti,  KliSlTVOFVEUMONT;  roN- 

mTTiN  i  .-UMOKON  TO   I  'IK  BliOOII.YN  EYE  AND  EAIt 

mopri'Ar.:  ex-fkesident  of  the  new  york 

.\(  .\DEMY0F>IEDK'INE:U0N0UAI{Y  MEMBEIt 

OK    THE    MEDICO-CUrRUUcaCAL   SOCIETY 

OF  EDINBURGH;  IIONOUAUY  FEI.r.OM- 

MF  THE   ACADEMY  OF  MEDKINK 

OF  HAVANA,  CUBA.  ETC., 

ETC. 


]Mon  cher  Maitre:  <^, 

Je  vous  dedie  ce  petit  livre  en  temoiage  de 
la  reconnaissance,  du  devouement  que  je  vous 
dois,  et  de  I'amitie  que  vous  avez  fait  naitre 
entre  nous.  c.  A.  W.  P. 


I 

0 


I 


INTRODUCTION. 


ib 


On  June,  1897,  I  had  the  honor  to  submit  to 
the  appreciation  of  the  Protessors  of  the  Fa- 
culty of  Medicine  of  Paris,  a  work  on  the 
"  mycosis  of  the  pharynx,"  suggested  to  me  by 
my  eminent  and  amiable  master,  Mr.  A,  Cas- 

tex. 

The  ''pharyngo-mycosis"  was  discovered  in 
1873,  by  Frsenkel,  of  Berlin,  and  since  then,  a 
great  number  of  cases  were  published,  the 
authors  all  concluding  that  the  mycosis  was  an 
accumulation  of  leptothrix  buccalis,  and  that 
this  microbe  was  the  cause  of  all  the  trouble. 

Two  years  ago  (1896),  M.  A.  Brown-Kelly,  of 
Glasgow,  said  that  the  mycosis,  already  des- 
cribed, was  nothing  but  hyperkeratosis,  this 
disease  being  characterized  by  an  accumulation 
of  corneous  tissue,  without  any  microbe.  After 
I  published  my  paper,  I  made  long  researches, 
consulting  very  carefully  the  bibliography,  I 
arrive  at  the  conclusion  that  in  the  said  *'my- 
cosis  of  the  pharynx"  we  always  find  all  the 
different  microbes  of  the  pharynx  and  of  the 
mouth,   infiltrated   in   a  corneous   tissue.     The 


description  g-iven  by  A.  Kelly  is  not  very  clear, 
and  I  do  not  agree  with  him  when  he  says  that 
hyperkeratosis  is  seen  without  mycosis.  So 
instead  of  having  two  different  diseases,  as 
proposed  by  Brown-Kelly,  I  would  suggest  that 
these  two  diseases  be  known  und^r  thje  name 
of  "hyperkerato-mycosis  of  the  pharynx."  I 
justify  plainly  my  proposal  in  the  course  of 
this  book. 

I  think  it  will  be  useful  to  give  an  entire  and 
complete  description  of  the  hyperkerato-niy- 
cosis,  its  history,  and  a  short  recapitulation  of 
what  was  said  by  all  the  other  authors. 


r 


n 


m 


HISTORIC    NOTES. 

In  1873,  B.  FraiKkel  published  for  the  first 
time  in  ''Medkal  Gazette  of  Berlin,''  an  article 
on  the  '-Benignant  mycosis  of  the  pharynx," 
and  immediately,  in  a  microscopic  examin- 
ation, he  has  stated  that  the  "lepto  rix  buc- 
calis,"  found  in  the  mycosic  spots,  was  the 
cause  of  that  disease. 

This  disease  had  never  before  been  described. 

In  1 876,  Baginski  and  Klebs  published  another 
case.  Klebs  found  the  "leptothrix  buccalis," 
and  confirms  the  distribution  of  the  filaments 
in  formof  fasces,  which,  according  to  M.  Charles 
Robin,  is  characteristic  of  that  leptothrix. 

In  1880,  B.  Frsenkel  published  his  second 
observation. 

In  1882,  E.  Frainkel,  of  Hamburg,  published 
in  his  turn,  a  case  of  tonsillary  mycosis."  The 
professor  S.^.debeck,  who  made  an  histological 
study  of  the  subject,  speaks  of  ihe  filaments 
seen  before  by  B.  Fraenkel,  Baginski  and  Klebs, 
but  he  thinks  that  these  are  the  products  of  a 
new  organism,  which  he  named  according  to 
its  shape  "bacillus  fasciculatus." 

Sadebeck  considers  as  spores  the  numerous 
grains  which  are  between  the  filaments,  while 
E.  Frsenkel  considers  that  spores  and  tipcats 


8 


HYPERKERATO-MYCOSIS 


represent  the  different  phases  of  development 
of  the  same  micro-organism. 

In  the  same  year,  1882,  Bayer  (of  Brussels) 
published  two  observations  in  the  '^Revuc  nien- 
suelle  de  Luryrtgologie,  etc." 

Also  in  1882,  Gumbiner  (of  Berlin)  published 
a  case. 

But  these  interesting  observations  forestalled 

somewhat  the  attention  of  the  laryngologists, 
for  in  the  same  epoch,  1882,  came  out  the  great 
book  on  the  diseases  of  the  larynx,  the  pharynx 
and  the  windpipe,  by  Morell-McKenzie.  In 
that  work,  where  the  diseases  of  the  pharynx 
are  minutely  treated,  the  word  "pharyngo- 
mycosis"  is  not  once  used. 

M.  Hering,  of  Varsovia,  published  six  obser- 
vations in  1884.  He  speaks,  under  the  name  of 
"pharyngo-mycosis,"  of  a  disease  of  the  tonsils 
and  of  the  basis  of  the  tongue,  characterized  by 
the  presence  of  small  whitish  and  grayish  spots, 
sometimes  globular,  more  often  pediculated; 
or  of  excrescences  having  the  form  of  thorns. 

In  1886,  Guinier  published  an  observation. 
From  that  time  a  few  specialists  studied  care- 
fully this  disease,  and  the  cases  became  more 
numerous. 

The  year  1887  was  very  fruitful  in  publica- 
tions on  this  disease. 


OF  THE  PHARYNX.  9 

Chiari  and  Creswell-Baber  each,  brought  in 
a  new  case. 

Mendes-Bonito,  of  Bordeaux,  published  his 
thesis  upon  this  subject,  with  twelve  obser- 
vations taken  in  the  service  of  Dr.  E.  J.  Moure. 

M.  Ferre  made  histological  researches  and 
found  the  "leptothri.v  buccalis.''  Dr.  Moure 
relates  that  there  were  only  twenty  cases  pub- 
lished, but  we  must  attribute  this  rareness  to 
the  fact,  that  the  disease  was  unknown,  and 
was  very  often  unobserved. 

At  the  congress  of  Oran,  in  1888,  Dr.  Moure 
says  that   he   considers   the    mycosis    of    the 
pharynx  ap  very  frequent. 

In  the  same  year  Lober,  Oltuszewski,  J  acob- 
son.  Decker  and  Seifert,  published  various 
communications  of  mycosis. 

The  following  year,  1889,  Vanderpool  de- 
scribed two  forms  to  the  mycosis;  the  circum- 
scribed and  the  diffuse  forms.  At  the  same 
time  Goris  found  muscular  fibres  with  the 
mycroscopic  examination,  but,  as  M.  Collin,  in 
his  thesis,  had  observed  it  advisedly,  the  wrench- 
ing of  the  white  spots  was  made  too  deeply,  and 
the  muscular  fibres  had  nothing  to  do  with  the 
disease. 

In  1889,  Gautier  published  an  article  on  the 
mycosis  in  Journal  of  Laryngology.     In  189T, 


10  HYPERKERATO-MYCOSIS 

Spaaus,    Piiternam,     Dubler,    Newcomb     and 
Jurasz,  published  different  articles.  . 

The  same  year  Lennox  Brown  published  his 
''Treatise  of  the  Diseases  of  the  Larynx,"  in 
which  he  devoted  twenty  lines  to  the  descrip- 
tion of  the  ''pharyngo-mycosis."  It  is  natur- 
ally an  insufficient  review  of  what  had  been 
said  of  that  disease. 

Henr>  3ixby  Hemenway,  (in  Journal  of 
Laryngology,  February,  1892)  wrote  an  article 
of  eleven  pages  on  the  history  of  ''pharyngo- 
mycosis"  and  its  microscopical  study.  He  found 
above  all  the  "leptothrix  buccalis"  and  the 
'bacillus  fasciculatus."  Then  he  recommends 
as   treatment,    the    thermo   and   galvano-cau- 

tery. 

Garel,  in  a  microscopical  study  of  the  disease 
found  the  ''leptothrix  buccalis"  and  the  "cocci 
bacillus  fasciculatus." 

Higguet,  of  Brussels,  found  in  the  white 
patches,  small  lamina   of  corneous  epidermis 

origin. 

In  TraitcdeMedecine  M.  Ruault  writes  a  few 
lines  on  the  different  diagnosis  with  the  chronic 
caseous  lacunary  tonsillitis. 

Bosworth  also,  in  1892,  in  his  "Treatise  of 
the  diseases  of  the  nose  and  throat,"  gives  a  few 
pages  to  the  description  of  that  disease. 


<; 


I 


.; 


I 


OF  THE  PHARYNX.  II 

M.  Albert  Colin,  in  1893,  published  his  thesis 
on  the  mycosis  and  seven  unpublished  observa- 
tions of  which  a  few  are  personals  and  the 
others  belong  to  the  service  of  M.  Ruault. 

M.  Colin  states  that  "always,"  the  leptothrix 
buccalis  is  the  cause  of  the  pharyngo-mycosis. 
M.  Colin  advised  the  use  of  smoking  tobacco, 
as  one  of  the  ways  of  treatment. 

M.  Wagnier  published  three  cases  of  recovery, 
by  touch  of  chromic  acid. 

M.  Eugene  Krauss  (in  Bulletin  Medical,  15  of 
March,  1893)  considers  the  catarrhal  state  as  a 
condition  "sine  qua  non"  of  the  development 
of  the  mycosis.  And  so,  the  different  causes, 
which  can  irritate  the  pharyngeal  mucous 
membrane,  can  indirectly  be  the  cause  of  the 
mycosis. 

M.  Labit  (in  Revue  de  Laryngologie,  ist  March, 
1893)  published  a  case  of  pharyngo-mycosis, 
whicn  is  rather  curious,  because  the  white 
patches  reached  the  aryteno-epiglottis  recess. 

In  1894,  Homer  M.  Thomas,  A.  M.,  M.  D.,  (in 
Medical  Record,  d  January,  1894)  gave  a  very 
good  description  of  the  disease,  but  without 
saying  anything  new.  He  advises  the  treat- 
ment with  cautery. 

In  1806.  Royet  (in  Echo  Medical  de  Lyon,  15 
August)  gave  a  very  good  description  of  the 


12 


HYPERKERATO-MYCOSIS 

"pharyngo-mycosis"  and  affirms  that  the  "lepto- 
thrixbuccalis"  exists  in  the  mouth  of  eight  per- 
sons out  of  ten  taken  at  random. 

In  the  same  year,  A.  Brown-Kelly  (in  Glas- 
gow Medicaljournal),  considers  that  the  disease 
called  ''pharyngo-mycosis"  is  in  reality  hyper- 
keratosis and  in  support  of  his  thesis  he  gives 
ten  personal  observations.  This  work  is  long 
and  conscientious,  but  is  not  convincing. 

The  small  lamina  of  corneus  epidermis  nature 
exist  always  in  the  pharyngo-mycosis,  and,  in 
the  meantime,  as  M.  Brown-Kelly  says,  simple 
gargarisms  are  not  sufficient  to  destroy  the 
''pharyngo  mycosis."  Beside  the  cases  of  spon- 
taneous recovery,  we  do  not  know  any  case 
which  was  so  docile  under  that  treatment  that 
we  can  call  "facetious." 


-^     W' 


OF  THE  PHARYNX. 


13 


■K  mt- 


PATHOLOGICAL  ANATOMY. 

Ever  since  1873  when  B.  Fraenkel  gave  the 
first  description  of  the  "hyperkerato-mycosis," 
the  specialists  have  been  on  the  **qui  vive,"  and 
every  year  the  observations  became  more 
numerous. 

Although  Krauss  believed  that  the  microscop- 
ical examination  was  unnecessary  in  making 
the  diagnosis,  most  of  the  observers  have  made 
a  bacteriological  study  of  all  their  cases.  As  a 
rule,  they  agree  to  acknowledge  the  "lepto- 
thrix  buccalis"  in  the  white  patches,  and  few  of 
them  deduct  from  the  constant  presence  of  the 
leptothrix   that  it  is   always   the  cause  of  the 

disease. 

Our  opinion  is  different.  The  leptothrix  buc- 
calis is  almost  constant  in  the  saliva  and  the 
different  parts  of  the  mouth;  it  would  be  aston- 
ishing if  we  could  not  see  it  in  the  diseases  of 
the  mouth,  and  according  to  the  bibliography 
that  we  have  to  consult  conscientiously,  and 
also  from  our  own  personal  researches,  we  can 
say  that  we  meet  not  only  the  'leptothrix  buc- 
calis, but  also  the  oi'dium  albicans,  the  nigri- 
ties  linguae,  the  mycosis  sarcine,  the  aspergiilus 
fumigatus,  etc." 


14 


HYPERKERATO-MYCOSIS 


And  for  the  present  time,  we  can  not  affirm 
that  the  leptothrix  is  the  bacillus  that  engen- 
ders the  hyperkerato-mycosis  of  th?  pharynx. 
Sometimes,  on  examination,  not  one  microbe  is 
seen;  nothing  can  be  seen  but  small  lamina  of 
corneous-epidermis  nature.  Our  amiable 
master,  M.  A.  Castex,  was  kind  enough  to  make 
us  a  gift  of  a  tuft  of  mycosis  taken  from  a  ton- 
sil of   one   of  his  patientr .     (Observation  No. 

V.) 

That  small  tuft,  or  in  preference  that  small 
point,  has  a  filiform  aspect,  having  a  length  of 
about  4  millimetres,  of  whitish  color,  having  a 
ravel  extremity,  sharply,  in  connection  with  the 
depth  of  the  crypts;  the  other  extremity  being 
swollen,    having    a  millimetre  and   a  half   of 
thickness,  is  connected  with  the  surface  of  the 
mucous   membranes  of  the  tonsil.     I  had  put 
first  that  small  nail  in  a  vial,  containing  a  solu- 
tion  ot   alcohol,  yl     Then,   two   days  after,  I 
could,thanks  to  the  extreme  obligingness  of  my 
master  and  friend,  M.  G.  Durante,  chief  of  the 
laboratory    of   pathological    anatomy    in    the 
"Charite's"  Hospital,  make  a  microscopical  ex- 
amination of  the  small  mycosic  tuft. 

The  disorganization  of  the  ravel  point,  cor- 
responding to  the  depth  of  the  crypt,  was  very 
easy.     I  could  even  crush  it  easily  on  the  glass 


OF  THE  PHARYNX. 


15 


plate.  Regarding  the  swallowing  extremity,  it 
was  differently,  and  besides  a  work  strength- 
ened with  patience,  the  microscopical  examina- 
tion was  impossible.  I  could  take  off  only  a 
few  particles.  The  other  part  was  hard,  cor- 
neous and  shining.  Then  I  submit  all  to  differ- 
ent proceedings  of  coloration. 
I  St.     With  a  solution: 

Anilina  water,  90  grammes. 
Alcoolic  concentrated  solutionof  thi- 
onin,  10  grammes. 

2nd.     With  the  liquid  of  Loeffler. 

3rd.     With  the  solution  of  fuchsin  (Gram). 

Naturally  I  took  care  to  fix  over  a  gas  Bun- 
sen,  before  the  coloration;  then  I  had  it  washed 
with  alcool,  and  I  covered  the  whole  thing 
with  Canada's  balsam. 

Accumulations  of  filaments  are  seen  with 
a  sometimes  considerable  length,  so  that  one 
filament  can  occupy  all  the  field  of  the  micro- 
scope. They  are  rectilineal  or  a  little  curved 
one  way,  sometimes  having  the  form  of  a  para- 
bola, rarely  sinuous. 

They  nearly  all  seemed  to  be  formed  of  fila- 
ments more  or  lesslong,  with  their  length  3  or 
4  times  greater  than  their  thickness. 

Their  diameter  is  sensibly  analogous,  i  milli- 
meter to  1.5  m. 


l6  HYPERKERATO-MYCOSIS 

These  micro-organisms  are  nothing  but  lep- 
tothrix  in  tufts. 

These  leptothrix  and  these  tufts  are  often 
found  growingonacell  of  flattened  epithelium, 
which  is  generally  granulosus  and  transparent. 
In  these  cells  are  recognized  a  series  of  other 
micro-organisms  which  are  the  common  mi- 
crobes of  the  mouth;  these  microbes  are  either 
round,  or  in  mass,  or  have  the  form  of  small 
sticks. 

Quite  a  number  of  cells  form  a  mass  filled 
with  these  round  microbes.  A  few  cells  con- 
tained several  of  these  varieties,  while  others 
contain  only  one  variety. 

All  the  granulosus  cells  which  seemed  to  be 
modified  with  a  small  magnifying  are  more  or 
less  filled  with  organisms. 

On  the  surface  of  the  mucous  membrane, 
where  the  leptothrix  is  planted,  we  see  some- 
times a  depression  in  which  the  corneous  epi- 
thelium continues  itself  with  the  mucous  body 
of  the  mucous  membrane. 

Filaments  of  leptothrix  are  planted  perpen- 
dicularly or  obliquely  on  the  first  corneous 
coat. 

Goris  had  found  fasces  of  leptothrii  isolated, 
cocci  associated  in  different  ways,  epithelial 
cells.     He  had   also   found   striated  muscular 


OF  THE  PHARYNX.  17 

fibres,  but  as  I  said  before,  the  extirpation  was 
probably  made  too  deeply,  beyond  the  sick  re- 
gion, in  the  muscular  plan. 

Garel  says  that  the  lymphoid  tissue  has  dis- 
appeared,and  that  a  fibro-conjunctivitis  stroma, 
in  which  the  vessels  are  atrophied,  has  taken 
its  place;  in  this  stroma,  the  crypts  are  repre- 
sented like  cavities,  real  cysts  by  retention, 
covered  by  an  accumulation  of  corneous  la- 
mella. Between  these  lamellas  exist  spores 
and  leptothrix.  It  seemed  as  if  the  crypt  was 
first  injured,  and  then  the  parasite  found  a  fav- 
orable ground  for  its  culture. 

Garel  adds  that  a  number  of  particles  of  my- 
cosis, taken  off  with  the  forceps,  offer  a  yellow- 
ish extremity,  ravel,  like  a  hard  cone,  corres- 
ponding with  the  depth  of  the  crypt.  This 
consistence  of  the  point  must,  according  to 
Garel,  proceed  from  incrusted  calcareous  salt; 
it  explains  beyond  the  difficulty  shown  often  in 
the  extraction  of  some  islets  of  mycosis. 

Krauss  pretends  that  when  the  parasite  has; 
succeeded  in  its  development  it  keeps  and 
exaggerates  the  irritation  of  the  mucous  mem- 
brane, because  it  penetrates  in  the  depth  of  the 
conjunctive  tissue,  in  the  interior  of  Ihe  glands,, 
and  in  the  follicles. 


l8  HYI'ERKERATO  MYCOSIS 

Krauss, after  a  microscopical  examination,has 
found  the  leptothrix,  that  took  a  blue  color, 
with  a  solution  of  iodine  and  of  iodide  of  potas- 
sium. Krauss  could  take  off  Ihe  mycosis  mass 
with  a  very  great  difficulty,  and  each  time  he 
was  obliged  to  use  violent  and  sudden  manoeu- 
vres which  had  produced  hemorrhage.  This 
difficulty  is  the  fact  that  the  parasite  had  pene- 
trated and  ramified  itself  in  the  depth  of  the 
tissues.  The  author  adds  that  it  is  hard  to 
disorganize  the  extirpated  mass  for  the  micro- 
scopical examination. 

Moure  (of  Bordeaux)  says  that  the  white 
tufts  are  composed  of  the  elements  of  the  lep- 
tothrix buccalis. 

Hemenway  also  believes  that  the  pharyngo- 
Tnycosis  is  due  to  a  parasite.  As  the  tonsils  are 
the  most  frequent  seat  of  the  parasites,  he  ad- 
vivsesto  call  if'tonsillo-mycosis." 

Higguet  (of  Brussels)  after  a  microscopical 
examination  of  the  white  spots  states  that  the 
iilaments  were  small  lamella  of  corneous  epi- 
dermis nature,  without  any  other  element.  This 
seems  much  like  Observation  V. 

Vanderpool  says  that  the  oidium  albicans  is 
the  most  frequent  vegetal  parasite  in  the 
pharynx.  The  others,  as  nigrities  linguse, 
mycosis  sarcine,   aspergillus,    are  more   rare. 


fif^ 


k 


OF  THE    PHARYNX,  19 

The  nigrities  linguae  is  seen  in  the  pharynx 
only  by  extension  in  the  neighborhood  of  the 
basis  of  the  tongue,  and  it  develops  itself  mostly 
on  that  organ.  The  aspergillnsis  more  frequent 
in  the  ear  than  in  the  pharynx. 

Gautier  says  that  the  caseous  masses,  seen  in 
the  crypts,  are  especially  composed  with  "lep- 
tothrix  buccalis."  The  disease,  according  to 
him,  attacks  in  preference  the  isthmus  of  the 
throat,  the  palatine  tonsils,  rarely  does  it  attack 
the  pharynx  and  the  trachea. 

According  to  Royet,  the  leptothrix  develops 
itself  mostly  on  the  part  of  the  tongue  situated 
before  the  lingual  V.  From  this  it  extends  in 
the  neighborhood.  He  adds  that  the  tufts  of 
leptothrix  are  placed  on  the  lingual  tonsil,  be- 
tween the  lobules  of  the  gland;  we  can  sec  them 
also  on  the  tonsils  of  the  palate,  on  the  mucous 
membrane  of  the  pharynx,  and  on  the  pharyn- 
geal tonsil. 


20 


HYPKRKERATO  MYCOSIS 


ETIOLOGY. 

Many  things  have  been  said  about  the 
etiology  of  the  hyperkerato-mycosis,  but  nearly 
every  one  agrees  that  this  is  obscure.  Our  re- 
searches were  not  more  fruitful  than  those  of 
our  predecessors. 

And  naturally,  knowing  nothing  exact,  many 
causes,  more  or  less  plaurWe,  were  incrimin- 

^  However,  it  seems  that  in  the  majority  of 
the  cases,  the  patients  seized  with  hyperkerato- 
mycosis  were  in  bad  health  and  presented  an 
alteration  of  the   pharyngeal  mucous    mem- 
brane.    Upon   that  question   Krauss  is    very 
energetic;  he  considers  that  a  catarrhal  state 
of    the    pharynx  is    a    condition     "sine    qua 
non"  of  the  development  of  the  mycosis,  and 
in  the  Bulletin  Medical,  15  March,  i?.>:'„  he  ex- 
pressed himself  to  that  effect.    "There  is  only 
one  fact  certain,  according  to  other  observerc- 
and  to  myself,  which  is,  that  the  mycosis  never 
grow  upon  an  undamaged  mucous  membrane, 
but  that  it  must  be  modeled  in  a  certain  way, 
before  the  appearance  of  the  mycosis. 

The  characteristic  of  that  modiBcation  is  not 
known  yet,  but  it  is  very  probable  that  the  least 


i 


OF  THF.  PHARYNX.  2  1 

alteration  of  the  mucous  membrane,  or  a  slight 
catarrh  is  sufficient  to  make  it  the  seat  of  the 
colonies  of  parasites." 

It  is  at  that  point  of  distance  that  all  the 
causes  which  can  irritate  the  mucous  mem- 
brane of  the  pharynx,  can  indirectly  cause  the 
hyperkerato-mycosir,. 

Garel,  in  1893,  after  a  study  of  twenty -nine 
cases,  says  that  the  disease  seems  to  develop 
itself  on  patients  seized  with  naso-pharyngeal 
catairh. 

Brown  Kelly,  in  1896,  affirmed  that  the  my- 
cosis develops  itself  by  means  of  a  bad  general 
or  local  state,  that  ha^.  modified  the  vitality  of 
the  mucous  membrane. 

The  dyspepsia  would  also  be  a  oause  of  that 

disease. 

The  dental  caries,  the  acidity  of  the  saliva, 
the  inflammation,  are  favorable  conditions;  also 
the  chronic  tonsillitis,  the  pharyngeal  catarrh. 

Hemenway  also  has  seen  the  disease  upon 
persons  having  a   catarrhal   inflammation   or 

large  tonsils. 

M.  Johnson,  of  BaltLxiore,  has  observed  these 
cases  especially  on  weaken  scholars  or  older 

people. 

In  the  thesis  of  Dr.  Colin,  1893,  it  is  repDrted 
that  a  pregnant  woman,  attacked  with  hyper- 


; 


22  HYPERKERATO  MYCOSIS 

kerato-mycosis,  was  absolutely  cured  after  her 
confinement. 

We  think  it  will  be  useful  to  reproduce  that 
observation. 

OBSERVATION    I. 

(Thesis  of  Dr.  .A    Colin,  1895.) 

Mrs.  X.,  21  years  old,  door-keeper.  One  day, 
her  daughter  was  seized  with  angina;  then  she 
thought  to  look  in  her  own  throat,  although 
she  did  not  feel  any  trouble,  and  saw  several 
white  spots  on  each  of  her  tonsils.  She  came, 
a  month  af^er,  the  nth  of  March,  1891,  to  the 
clinic  of  laryngology,  at  the  "Institution  des 
Sourds-Muets,"  and  then,  the  tonsils  were  cov- 
ered in  numerous  places  with  small  excres- 
censes  of  a  white  yellowish. 

Analogous  excrescences  were  seen  also  on 
the  back  wall  of  the  pharynx  and  on  the  basis 
of  the  tongue 

These  productions  were  of  a  hard  consis- 
tence and  were  taken  away  with  difficulty^ 
with  the  dull  forceps. 

Diagnosis. — Leptothrix-mycosis,  recognized 
with  the  microscope. 

Treatment. — Ablation  of  the  tufts  of  mycosis 
and  washing  with  a  solution  of  iodine  with  I  K. 

We  met  that  door-keeper  again  on  the  15th 
of   March,  1892;  she  declared  that  one  month 


^ 


<1> 


^ 


^ 


II 


OF  THE  PHARYNX. 

after  her  first  visit  she  saw  new  white  spots  on 
the  right  tonsil,  which  were  treated  for  a  little 
time  with  lemon  juice. 

She  was  confmed  on  April  last.  At  that  mo- 
ment, she  still  had  mycosic  productions  that 
had  come  back  in  greater  number,  since  she 
had  stopped  the  treatment. 

The  first  time  she  got  up,  two  weeks  after 
her  confinement,  she  looked  at  her  throat  and 
saw  that  there  were  no  more  white  spots  there. 

We  examined  her,  and  saw  in  fact  that  all 
the  parts  that  have  been  touched  formerly, 
were  cured,  and  that  there  was  nowhere  any 
productions  of  m}  cosis. 

According  to  C.  Robin,  the  acidity  of  the 
saliva  is  a  condition  of  life  for  the  "leptothrix- 
buccalis." 

Mendes-Bonito  thinks  that  the  irritations  of 
the  pharynx,  favoring  this  acidity  of  the  saliva, 
would  be  the  cai.se  of  the  mycosis. 

But  Decker  and  Seiferthaveinoculated  some 
leptothrix  upon  sound  and  sick  tonsils,  and  in. 
each  case,  have  reproduced  the  disease. 

Our  master,  M.  A.  Castex,  has  seen  that  dis- 
ease upon  a  young  English  girl  of  thirteen 
years,  who  used  to  have  tonsillitis  frequently. 
(Observation  VI.) 


24  HYPERKERATO-MYCOSIS 

Thomas  says  that  the  women  and  ^he  chil- 
dren who  are  seized  with  hypertrophy  of  the 
tonsils  or  of  chronical  pharyngitis  are  more 
predisposed  to  that  di.  ease. 

W.  C.  Glasgow  says  that  the  hyperkerato- 
mycosis  develops  itself  only  when  the  mucous 
membrane  of  the  pharynx  offers  a  favorable 
ground. 

But  very  often,  the  cause  is  unknown,  so  that 
persons  have  the  disease  for  a  long  time  before 
it  is  discovered  b)^  chance;  there  are  cases  of 
singers  who  feel  nothing  at  all  when  their 
voice  is  at  rest,  but  after  they  sing  for  a  while, 
they  are  forced  to  discontinue.  (Observation 
V.) 

The  development  of  the  disease  is  by  no 
means  influenced  by  the  age,  the  sex,  or  the 
profession  of  the  individuals.  However,  ac- 
cording to  several  authors,  it  would  be  more 
frequent  with  women  attacked  then  between 
ten  and  forty  years  ot  age. 

In  132  cases,  Brown-Kelly  has  calculated  5:! 
men  and  78  women;  being  between  15  and  35 
years  of  age. 

It  was  seen  by  Garel  more  frequently  during 
childhood;  upon  young  girls  between  10  and 
20  years  of  age. 


OF  THE  PHARYNX.  25 

tn  29  cases,  14  men,  15  women.  Vanderpool 
says  that  the  disease  is  more  frequent  in  wo- 
men than  in  men,  and  especially  at  about  30 
years  of  age. 

In  the  thesis  of  M.  A.  Colin,  there  are  six 
women  and  only  one  man,  their  age  being 
from  II  to  30  years. 

Colin  gives  the  following  proportion:  Three 
women  for  two  men. 

Hering  saw  it  in  an  old  man. 

Dubler  saw  it  in  a  child  of  8  months. 

M.  A.  Castex,  on  a  total  of  6  persons,  num- 
bers 2  women,  3  young  girls  and  one  man. 

Hemenway  believes  that  the  disease  is  more 
frequent  in  women  than  men,  because  the  wo- 
men live  in  an  impure  air  and  he  adds  that  the 
hypertrophy  of  the  tonsils  is  a  favorable  ground 
for  the  parasite. 

The  hygienic  conditions,  (food,  temperature, 
dampness,  ventilation,  etc.),  to  which  Gorishad 
given  an  etiological  value,  have  nothing  but 
an  indirect  importance  in  favoring  a  catarrhal 
condition  of  the  mucous  membrane. 

It  is  not  proved  yet  that  a  predisposition  to 
the  syphilis,  tuberculosis,  etc.,  might  be  a 
cause. 

Most  or  the  patients  observed,  were  free  of 
previous  diseases. 


26 


HYFKRKERATO  MYCOSIS 


There  is  no  hereditary  predisposition,  al- 
though the  disease  may  be  seen  on  different 
members  of  the  same  family. 

Nevertheless,  Guinier  thinks  that  the  lym- 
phatism  is  an  excellent  ground  to  the  develop- 
ment of  the  leptothrix. 

On  the  contrary,  it  was  stated  that  the  ma- 
jority of  the  patients  were  healthy. 

M.  A.  Castex  has  seen  it  six  times  in  his  pri^ 
vate  office:  never  at  his  clinic.  (Observations 
V  and  VI.) 

Garel  has  seen  it  twice  at  the  hospital  and  27 
times  at  his  office. 

Goris  says  that  a  cold  is  cause  o    the  disease. 
.  Without  exact  proofs,  the  damp  climate,  the 
quality  of  swamp  water,  because  it  contains  ba- 
cillus that  resembles  1;he  "leptothrix-bacillus," 
were  incriminated.  (Thomas  and  Hemenway.) 

The  disease  is  not  directly  transmissable  and 
is  not  contagious.  Hemenway  had  experi- 
mented on  himself  the  transplantation  of  ex- 
crescences, but  without  success. 

After  all,  the  etiology  of  the  **hyperkerato- 
mycosis"  is  uncertain;  but  if  we  make  the  n^^' 
croscopical  examination  of  the  white  spots 
found  on  the  tonsils  and  on  the  basis,  of  the  ton- 
gue, we  see  different  microbes,  which  could^ 
alone,  explain  the  disease. 


. 


OF  THE  PHARYNX.  *  2/ 

Of  all  those  microbes,  which  one  is  to  be  in- 
criminat'  ^5  especially  as  the  etiology  of  the 
mycosis?  Or,  in  preference,  are  these  different 
microbes  associated,  the  cause  of  the  disease  ? 
Our  opinion  upon  that  question  is  not  quite 
firm.  After  a  light  examination,  nearly  all  the 
observers  had  seen  the  "leptothrix-buccalis." 
But  this  microbe  is  always  in  the  mouth  nor- 
mally and  a  "fortiori,"  v.  hen  the  mouth  is  sick. 

The  following  microbes  have  been  seen  also: 
oidium  albicans,  nigrities  linguae,  sarcinica, 
actinomyces,  aspergillus  fumigatus  and  ba- 
cillus f asciculatus.  So  these  different  microbes 
seem  to  be  the  cause  of  the  mycosis,  but  some 
other  unknown  special  conditions  are  necessary. 


28 


HYPERKERATO-MYCOSIS 


DESCRIPTION. 

Definition.— The  "hyperkerato-mycosis  of 
the  pharynx"  is  a  benignant  and  chronic  dis- 
ease, characterized  by  the  presence  on  the 
different  tonsils,  on  the  basis  of  the  tongue 
and  sometimes  on  the  whole  pharynx,  of  small 
white  spots  having  a  diameter  of  i  to  2  milli- 
meters, containing  the  different  microbes  which 
are  found  in  the  mouth,  and  a  certain  quantity 
of  corneous  tissue. 

For  its  description,  we  must  study  first  the 
subjective  symptoms  and  afterwards  the  ob- 
jective signs. 


I 


OF  THE  PHARYNX. 


29 


"   f 


- 


SUBJECTIVE  SYMPTOMS. 
We  must  first  say  that  these  are  sometimes 
null  and  that  often,  the  disease  is  discovered 
by  a  mere  chance,  as  in  the  case  of  a  lady  who 
came  to  consult  M.  Krauss,  because  she  had 
seen  for  many  months  some  white  spots  on 
her  tonsils,  which  were  not  at  all  annoying,  but 
did  not  disappear. 

Royet  says  that  it  is  hard  to  suspect  the  pres- 
ence of  the  parasite,  if  there  is  no  pharyngitis. 
The  singers  can  have  the  disease  without 
apparent  symptoms,  only  after  having  sung  for 
a  little  while,  they  have  a  feeling  of  dryness 
and  of  irritation  in  the  isthmus  of  the  throat. 

The  voice  is  diminished  in  regard  to  the  tone, 
and  becomes  hoarse. 

Nykamp  cites  the  case  of  a  patient  who  "com- 
plained  of  nothing,"  although  there  were  gray- 
ish spots  of  hyperkerato-mycosis  between  the 
papilla  of  the  back  of  the  tongue  and  upon  the 
epiglottis.  The  pharynx  and  the  tonsils  were 
indemnified. 

Garel  says  that  the  symptomology  is  entirely 
objective;  and  that  rarely,  there  is  uneasiness 
and  pain  with  deglutition.  We  believe  that  it 
will  be  interesting  to  publish  the  observation  of 
a  young  woman  who  was  seized  with  hyper- 


30  HYPERKERATO-MYCOSIS 

kerato-mycosis  without  any  subjective  symp- 
toms. 

OBSERVATION    II. 

(Dr.  Eugene  Krauss.) 
Chambermaid,  28  years  old,  living  in  the  best 
hygienic  conditions.  When  I  saw  her  for  the 
first  time,  she  had  seen  for  eight  months  some 
white  stains  on  the  tonsils.  No  acute  phenom- 
ena (fever,  dysphagia,  etc).  On  examining  the 
pharyngeal  cavity,  the  mucous  membrane   of 

the  palate,  of  the  pillars,  was  seen  to  be  slightly 
congested. 

On  each  of  the  hypertrophied  tonsils  having 
the  length  of  a  hazel-nut,  covered  with  a  thick 
mucous  membrane,  of  red  grayish  color,  we  see 
a  dozen  white  spots,  regularly  disseminated, 
and  seeming  to  be  very  distinct  of  the  mucous 
membrane.  All  these  points  have  about  the 
dimensions  of  a  millet-grass;  of  a  white 
nacreous  color;  some  of  them  are  covered  with 
a  yellowish  coat  of  mucus. 

When  examined  more  closely  wt  see  that 
they  are  small  pointed  elevations,  of  which  the 
surface  seemed  villous,  having  then  the  appear- 
ance of  small  tufts. 

Nowhere  are  these  stains  confluent,  and  they 
are  very  isolated  by  the  mucous  membrane  that 
surrounds  them. 


OF  THE  PHARYNX.  31 

With  the  laryngoscope,  we  discover  twenty 
other  spots  on  the  basis  of  ^he  tongue,  which 
are  grouped  around  the  large  follicles. 

There  is  nothing,  abnormal  in  the  other 
regions  of  the  pharynx  or  of  the  nose. 

But  it  is  not  always  l>o,  and  the  subjective 
symptoms  exist  often. 

The  disease,  in  six  patients  of  my  master,  M. 
A.  Castex,  was  always  characterized  by  an  un- 
easiness or  sensation  of  stitching  in  the  pharynx, 
which  symptoms  are  the  most  frequent. 

In  an  observation  in  the  thesis  of  M.  A.  Co)  in, 
the  patient  complains  of  an  uneasiness,  a  tick- 
ling, a  sensation  of  foreign  body  that  made  her 
cough  and  so  ape  constantly.  Sometimes  there 
is  also  a  sensation  of  dryness;  there  is  the  sen- 
sation of  a  band  around  the  neck,  which  would 
suffocate  the  patient,  if  pressed  slightly.  Also 
it  is  painful  for  the  deglutition. 

Thomas  has  seen  all  those  symptoms,  greatly 
exaggerated,  with  weakness,  fever  and  loss  of 
appetite. 

The  breathing  was  rarely  offensive,  but  was 
reported.  (Gautier.) 

Moure  says  that  when  the  subjective  symp- 
toms exist,  they  «-  e  like  granulosus  pharyngitis. 

Hemenway  says  that  the  symptoms  vary 
from  a  sensation  of  pricking,  until  there  is  a 


32  HYPERKERATO-MYCOSIS 

sensation  of  obstruction.  The  local  inflam- 
mation,  painful  with  fever,  cough  and  vomiting, 
is  seen  sometimes.     Also  asthma. 

As  a  rule,  the  whole  system  is  in  good  con- 
dition. 


OF  THE  PHARYNX. 


3S 


OBJECTIVE  SYMPTOMS. 

As  it  is  said  of  our  definitior  of  the  "hyper- 
kerato-mycosis  of  the  pharynx,"  the  objective 
symptoms  of  that  disease  are  the  presence  of 
small  whitish  spots  on  the  tonsils  and  on  the 
basis  of  the  tongue,  but  it  is  not  always  so. 

Sometimes  the  hyperkerato-mycosic  spots 
are  seen  on  the  epiglottis  and  not  on  the  ton- 
sils. The  points  have  the  form  of  tufts  pro- 
jecting a  few  millimeters  over  the  mucous 
membrane.  '  ■ 

They  resemble  sometimes  a  small  nail's  head. 

Their  surface  is  plain  or  irregular,  fimbriate, 
of  a  yellowish  white  color;  these  spots  are 
taken  off  with  great  difficulty,  according  to  the 
penetration  of  the  microbes  in  the  th^''  ""vness 
of  the  mucous  membrane;  the  plucking  t,ume- 
times  gives  an  oozing  of  blood.  These  hyper- 
kerato-mycosic points  have  often  the  form  of 
millet  grass  or  tufts  of  mushrooms,  resembling 
the  appearance  of  capuchin's  bearb,  or  the 
yellowish  stains  like  in  diphtheria.  The  touch 
gives  the  sensation  of  protuberance. 

Thomas  gives  two  forms  in  the  description 
of  these  points;  the  diffused  form  and  the  cir- 
cumscribed form.     In  the  diffused  form,    the 


34  HVPKRKEKATO-MVCOSIS 

tongue  is  entirely  covered  with  a  brilliant  mass 
like  milk,  that  is  frequently  very  dense. 

The  movements  of  the  tongue,  and  the  sen- 
sation of  the  taste  are  not  lost,  and  the  whole 
condition  of  the  patient  is  good. 

In  the  circumscribed  form,  some  white  spots 
appeared,  and  the  mucous  membrane  has  a 
pini.  color. 

The  following  description  belongs  to  Brown- 
Kelly. 

"The  patches  are  m  jre  or  less  numerous, 
small,  isolated,  slightly  projecting,  having  their 
seat  on  a  sound  mucous  membrane,  are  taken 
off  easily,  with  a  superficial  erosion. 

They  are  seen  generally  on  the  uvula,  and  on 
the  veil  of  the  palate." 

The  principal  characteristic  of  these  hyper- 
kerato-mycosic  nails  is  their  adhesion;  and 
after  being  taken  off  with  the  forceps,  they  re- 
appear rapidly  in  the  same  place,  sometimes 
.after  twenty-four  hours. 

Sometimes,  ^hcse  filaments  gather  together 
and  form  a  membraiie. 

Atothertimes,theyare  corneous  and  pointed, 
having  the  form  of  clusters,  or  having  the 
form  of  muscular  stains. 

The  lesion  seats,  by  order  of  frequency,  at 
the  tonsils,   the   basis   of   the   tongue,   in   the 


OF  THE  PHARYNX.  35 

glosso-epiglottical  dimples,  the  posterior  and 
lateral  walls  of  the  pharynx,  in  the  middle  of 
the  pillars  of  the  naso-pharyn^eal  vault  of  the 
nares. 

OHiiszewski  observes  a  case  of  a  sick  person 
of  16  years  of  age,  on  whom  the  disease  was 
suddenly  seen  on  the  tonsils,  the  palatal  arches 
and  the  tongue  with  intense  fever. 

Vanderpool  says  that  the  seat  of  predilection 
is  the  left  tonsil. 

The  progress  of  the  disease  is  slow;  at  times 
it  disappears  spontaneously.  We  reproduce 
here  an  observation  of  hyperkerato-mycosis, 
which  is  generalized,diffuse,  rare,  consequently 
interestinp",  the  place  of  which  is  indicated  in 
this  book. 

OBSE^clVATION    III. 

(Dr.  Lsihit,  in  Revue  i/e  Larj/n£v,  iSg^-) 
Mary  G.,  28  years  old.  This  person,  of  a 
sickly  aspect,  thin  and  very  nervous,  says  she 
is  incommodated  moic  bv  her  general  state 
than  that  of  her  throat,  although  she  is  per- 
suaded that  the  throat  is  the  cause  of  all  her 
trouble. 

In  the  examination  of  her  throat,  we  perceive 
numerous  white  spots,  coverin^j  the  right  ton- 
sils, especially  towards  the  center  and  forming 
there  a  nest  of  about  one  centimetre  in  width. 


" 


HYPERKERATO-MYCOSIS 

On  the  left  tonsil  the  white  spots  are  more 
disseminated. 

A  ft,v\  wrrite  spots  are  seen  on  the  left  lateral 
wall  c'  'he  local  pharynx  and  on  the  most  ex- 
treme part  of  the  anterior  pillars  on  both  sides. 

With  the  mirror,  we  see  that  tissue  of  the 
basis  of  the  tongue  is  covered  by  small  white 
spots,  separated,  and  as  large  as  pin  heads,  lo 
to  12  in  number. 

At  the  right  side  of  the  basis  of  the  tongue, 
near  the  epiglottis  and  on  the  anterior  part  of 
the  ary-epiglottical  fold  of  the  same  side,  we 
see  two  white  spots  of  about  3  millimetres  long 
and  4  millimetres  wide;  nothing  is  seen  on  the 

pharynx. 

We  perceive  spots,  similar  to  the  preceding 
ones  on  the  lateral  walls  of  the  naso-pharynx,, 
especially  at  the  left,  at  the  entrance   of   the 
Eustachian  tube  on  both  sides,  lastly  on  the 

posterior  wall. 

All  those  white  spots  have  the  aspect  of  small 
projecting  tufts  of  "  to  5  millimetres  long,  with 
denticulated  and  fimbriate  ends. 

The  mucous  membrane  surrounding  these 
small  points  is  sound. 

The   touching,  also,  gives  the   sensation   of 

projecture. 


L 


*  ^ 


n 


'■ 


*  & 


OF  THE  PHARYNX.  37 

The  extirpation  of  some  of  these  tufts  is 
attempted,  and  shows  that  they  adhere  strongly 
to  the  mucous  membrane. 

The  microscopical  examination  shows  the 
presence  of  the  leptothrix  Luccalis. 


38 


HYPEKKEKATO-MVCOSIS 


DIAGNOSIS. 

The  diagnosis  of  the  ^'hyperkerato-mycosis" 
is  generally  an  easy  matter,  when  the  disease 
is  characterized  by  small  white  points,  about 
the  size  of  a  millet-grass  disposed  around  the 
tonsils  and  the  basis  of  the  tongue,  on  a  sound 
mucous  membrane,  of  long  duration  a!  d  pulled 
out  with  difficulty  with  the  forceps. 

All  doubts  are  taken  away  when  in  the  mi- 
croscopical examination  the  points  contain  the 
micro-organisms  of  the  mouth,  or  epithelial 
cells,  or  lamina  of  epidermic  corneous  nature. 

If  the  subjective  symptoms  are  not  very 
marked,  it  is  in  favor  of  the  ''hyperkerato-my- 
cosis." 

Generally,  the  diagnosis  is  easily  made,  but 
in  some  rare  cases,  the  observer  must  have  a 
thorough  knowledge  of  the  different  diseases 
of  the  pharynx. 

The  foUicularis  angina  evolutes  in  an  acute 
manner;  it  is  accompanied  with  fever  and  in- 
tense dysphagia.  The  white  spots  that  it  pro- 
duces are  irregular  in  form  and  size:  they  have 
a  pronounced  tendency  to  confluence  and  seat 
on  the  congested  tonsil.. 


■• 


" 


OF  THE  PHARYNX.  39 

All  the  points  in  a  lacunaris  tonsillitis  are 
soft  and  friable,  halt  liquid  andjnot; adherent; 
they  are  easily  pulled  out  with  the;'stylet. 

The  fact  that  the  authors,  Labit,  L.  Brown- 
Kelly,  Garel,  Vanderpool,  Hemenway,  Krauss, 
gave  to  the  diagnostical  study  of  the  foUicu- 
laris  pharyngitis  with  the  hyperkerato-mycosis, 
a  particular  interest,  would  make  us  hesitate 
sometimes  in  our  diagnosis. 

Diphtheriahardly  resembles  the  hyperkerato- 
mycosis.  Here  the  disease  is  chronic,  without 
fever  and  general  symptoms,  except  in  the  case 
of  concomitant  tonsillitis,  without^cliphtherical 
smell,  or  any  pain;  the  objective  examination 
of  the  throat  is  also  entirely  different. 

If  the  white  tufts  have  the  form  of  a  mem- 
brane, it  is  taken  off  only  in  fragments,  it 
leaves  bleeding  stains,  but  the  mucous  mem- 
brane is  much  less  denuded  than'in  diphtheria. 
Although  Vanderpool  considers  that  the  hy- 
perkerato-mycosis has  often  been  confused 
with  diphtheria. 

The  microscope  can,  however,  always  decide 
the  question,  the  Klebs  and  Loeftier's;  bacillus 
being  always  easily  distinguished. 

I  do  not  insist  on  the  gravity  of  the  fault  that 
we  would  commit  in  making  a  mistake  in  the 
diagnosis. 


40  HYPERKERATO-MYCOSIS 

The  appearance  of  mucous  stains  in  the 
throat  is  alwj^ys  accompanied  by  other  symp- 
toms of  the  syphilis  (angina,  glands,  etc.);  the 
stains  themselves  do  not  have  the  pointed  form 
of  the  mycosic  colonies  and  are  larger. 

Tuberculosis  resembles  in  a  very  vague  way 
the  hyperkerato-mycosis  and  only,  under  the 
form  ot  miliary  phthisis  of  the  pharynx,  which 
is  declared  in  the  last  stage  of  tuberculosis. 

The  general  appearance  of  the  patient,  the 
anemia  of  the  mucous  membrane,  the  yellowish 
color  and  the  transparence  of  the  small  nodules 
that  are  produced  ia  the  throat  of  the  patient, 
makes  the  diagnosis  easy. 

Sometimes  there  are  some  wisps  of  mucosities 
and  of  epithelial  cells  in  the  chasms  of  the  ton- 
sils. They  are  of  a  yellowish  color,  above  the 
size  of  a  millet-grass  and  are  found  isolated 
and  in  small  number  and  are  characterized  by 
the  extreme  facility  with  which  they  are  taken 
•off.  Alight  pression,  a  fit  of  coughing  are  suf- 
ficient to  take  them  out  of  their  cells. 

We  also  observe  small  cysts  in  the  chasms  of 
the  tonsils;  they  form  flat,  transparent,  yellow- 
ish elevations;  they  are  always  isolated  and 
generally  occupy  the  summit  of  the  tonsils. 

The  "thrush,"  a  pre-eminently  children's  dis- 
ease, may  sometimes  attain  adults.  The  thrush 


*   ?) 


OF  THE   PHARYNX.  4I 

forms  white  membranes,  of  various  sizes,  that 
may  be  seated  on  every  part  of  the  mucous 
membrane  of  the  mouth  and  of  the  pharynx, 
but  are  principally  seen  on  the  sides  of  the  ton- 
gue and  on  its  basis.  They  have  a  tendency  to 
confluence  and  are  easily  detached  by  rubbings. 
Underneath,  the  mucous  membrane  is  not 
ulcerated,  but  only  congested  and  of  a  dark  red. 
The  patient  is  generally  in  a  cachectic  state; 
there  is  also  dysphagia. 

In  the  case  of  "calcareous  concretions''  of  the 
tonsils,  they  are  larger  than  the  white  spots  of 
the  hyperkerato-mycosis  and  give,  under  the 
stylet  a  stony  sound,  which  does  not  exist  in 
the  preceding  disease. 

They  are  isolated  and  do  not  reappear  after 
their  removal. 

The  "caseous"  concretions  of  thegranulosus- 
pharynx,  may  be  similar  to  the  hyperkerato- 
mycosis,  but  are  still  distinguished  from  it,  by 
their  being  softer  and  much  less  adherent. 

There  cannot  be  any  confusion  with  the 
herpes  of  the  pharynx,  because  of  the  fever 
and  general  discomfort,  i-hat  does  not  exist  in 
the  hyperkerato-mycosis. 

Although  certain  light  herpetic  anginas  can 
cause  no  general  reaction,  the  distinction  will 
be   easy  because   the   vesicles   of    herpes  are 


42 


HYPERKl!.i^ATO-MYCOSlS 


iated 


)f 


palate 


principally 

never  on  the  basis  of  the  tongue,  which  is  gen- 
erally reverse  in  the  hyperkerato-mycosis. 

Krauss  reporis  the  case  of  an  "infectious  an- 
gina" (caused  by  stuffed  birds)  which  was  seen 
under  the  form  of  an  intense  follicularis  an- 
gina, accompanied  by  fever  and  by  grave  pros- 
tration. 

After  a  few  days  these  symptoms  ceased  and 
reappeared  only  at  intervals  of  two  or  three 
weeks. 

The  patient  did  not  suffer  during  those  in- 
tervals, but  had  small  white  spots  on  the  ton- 
sils, that  resembled  those  produced  by  the 
leptothrix. 

The  acute  characteristics  distinguished  also 
this  affection  from  the  hyperkerato-mycosis. 

According  to  Brown-Kelly,  there  is  a  perfect 
clinical  difference  between  the  so-called  dis- 
eases, mycosis  and  hyperkeratosis.  He  says 
that  the  only  resemblance  is  the  presence  of 
the  leptothrix  in  their  productions. 

The  excrescences  of  the  hyperkeratosis  are 
rough,  very  adherent  and  of  characteristic 
form. 

The  stains  of  the  mycosis  are  smooth  to  the 
touch,  easy  to  take  off  and  slightly  prominent 


" 


' 


t 


OF  THE  PHARYNX. 


43 


" 


' 


and  the  surrounding  mucous  membrane  is 
swollen. 

The  hyperkeratosis,  he  says,  is  limited  to  a 
certain  region,  while  the  mycosis  has  been  ob- 
served on  every  point,  between  the  mouth  and 
the  stomach. 

The  diagnosis  of  the  disease  is  easy,  when  it 
has  developed;  at  the  beginning,  the  difficulty 
consists  in  discovering  the  colonies  which  are 
not  yet  numerous  and  which  occupy  the  secrete 
places  of  the  mucous  membrane,  such  as  the 
posterior  part  of  the  tonsils,  the  folds  of  the 
tongue,  etc.,  and  besides,  the  precise  diagnosis 
is  always  desirable,  but  it  is  not  essential,  to 
apply  to  a  convenient  treatment. 

It  is  nevertheless  important  not  to  confound 
the  hyperkerato-mycosis  with  the  follicularis 
pharyngitis. 


"■i"i!^%'r:.    "'iv:-,/ 


k-Mi^Iftiyl'v: 


44 


HYPERKER  A  TO- MYCOSIS 


PROGNOSIS. 

The  prognosis  is  favorable,  in  spite  of  a  des- 
pairing resistance  of  the  parasite  to  the  treat- 
ment. 

The  recovery  is  sometimes  spontaneous,  but 
more  often,  the  disease  is  chronic  and  has  sev- 
eral returns. 

Hemenway  thinks  that  the  parasite  can  run 
away  in  the  pituary  or  in  the  lungs. 

Being  in  the  lungs,  they  can  produce  a  very 
obstinate  bronchitis. 


OF  THE  PHARYNX, 


45 


TREATMENT. 

It  is  very  important  to  recogixize  the  hyper-^ 
kerato-mycosis  at  its  beginning,  for  then  the 
parasite  has  its  seat  on  the  superficial  mucous 
membrane,  and  may  be  destroyed  easily. 

Later,  th^  treatment  is  longer  and  more  diffi- 
cult. 

The  different  antiseptic  medicaments,  astrin- 
gent or  caustic,  the  carbolic  acid,  chromic, 
boracic  or  salicylic  acid,  the  bichloride  of  mer- 
cury, the  nitrate  of  silver,  the  alcool,  etc.,  even 
in  concentrated  solutions,  have  no  effect  on  the 
disease.     (Observation  lY.) 

Our  master,  M.  A.  H^stex,  extols  the  hot 
gargles  with  a  i^  solution  of  resorcin,  accom- 
panied with  the  extirpation  several  times  of  the 
mycosic  spots,  with  the  nasal  forceps  of  Duplay. 

(Observation  V.) 

Sometimes  the  galvano-cautery  is  successful. 

(Observations  VI  and  VII.) 

The  cautery,  galvano  or  thermo  is  also  in 
favpr  with  Hemenway. 

Moure  affirms  that  the  only  treatment  is  the 
picking  or  the  scraping  off  of  the  tufts,  accom- 
panied with  cauterization  of  their  points  of  im- 


4^  HPPERKERATO-MYCOSIS 

plantation  with  a   solution  of  chloride  of   zinc 
(A  to -jjJjj-)  of  lactic  acid  (>^  or  pure). 

He  employs  also  the  thermo-cautery  for  the 
tonsils  and  the  g-alvano-cautery  for  the  basis  of 
the  tongue. 

Garel  recommends  the  picking  off  with  the 
forceps,  and  cauterizations  with  galvano- 
cautery. 

M.  Natier  had  cured  a  young  girl  with  gal- 
vano-cautery  and  chloride  of  zinc. 

M.  Webster,  in  a  case  of  hyperkerato-mycosis, 
had  employed  successfully  the  galvano-cautery 
and  the  hyposulphite  of  sodium. 

M.  Frederick  Knight  (of  Boston),  when  using 
the  galvano-caustic  needle,  has  succeeded  only 
when  it  penetrated  deeply  in  each  follicle. 

The  disappearance  of  all  the  spots  came  after 
gargles  of  a  solution  of  chinolin  (io%)  and  gal- 
vano-cautery, in  the  hands  of  Nykamp. 

Goris  prefers  the  touching  of  the  points  with 
bichloride  of  mercury  and  extirpation  with  the 
forceps.  When  the  parasite  has  not  penetrated 
deeply  he  prefers  the  galvano-caustic. 

M.  Hower-Thonias  affirms  that  the  using  of 
galvano-cautery  is  the  only  good  treatment. 

M.  Krauss  has  several  times  employed  the 
galvano-cautery  in  a  very  energetic  way,  but 
he  never  could  make  a  complete  cure.  To  have 


; 


. 


. 


OF    IHF,    PHARYNX.  47 

a  good  result  he  was  obliged  to  extirpate  first 
the  mycosic  points  with  the  forceps. 

He  adds  that  it  is  important  not  to  lose  sight 
of  the  patient  and  have  to  begin  again  the 
t^^atment  when  the  parasite  reappeared,  as  is 
the  rule  at  the  beginning  of  the  treatment.  The 
parasite  wastes  after  a  certain  time,  and  then 
the  obstinate  disease  can  be  cured  radically. 

Most  of  the  authors  agree  that  the  sole  treat- 
ment of  the  hyperkerato-mycosisis  ''extirpation 
of  the  mycosic  spots  with  a  forceps,  cauterizing 
with  galvano-cautery  and  simultaneous  anti- 
septic gargles." 

Other  treatments  seemed  to  have  given  good 
results,  how^ever. 

M.  Wagnier  is  said  to  have  cured  two  patients 
by  touching  the  white  spots  with  chromic  acid, 
having  failed  with  the  other  treatment. 

According  to  Moure,  this  treatment  is  not 
without  danger,  chromic  acid  being  poison  even 
in  small  quantity. 

M.  Delavan  had  the  best  -esults  with  borax 
and  bichloride  of  mercury,  and  especially  with 
the  suppression  of  dyspepsia. 

M.  Kitchen  recommends  the  hyposulphite  of 

sodium. 

The  Hydrogen  Dioxide  (H2  O2)  was  also  ex- 
toled.  and  for   that  purpose  I  recommend  the 


48  HVPERKKRATO-MVCOSIS 

Marchand's  Hydrozone  as  the  best  preparation 
of  Hydrogen  Dioxide. 

M.  vSemon  had  cured  a  patient  with  chlorate 
of  potassium  gargles,  and  touches  with  tannic 
acid. 

Alum  and  the  nitrate  of  silver  have  not  given 
good  results. 

M.  Jacobson  recommends  the  bichloride  of 
mercury  (2-1000). 

M.  Toeplitz  had  tried  the  iron  salts  without 
success. 

M.  M.  deNabias  and  Sabrazes  and  M.  Labit 
have  obtained  good  results  with  the  following 
treatment: 

Ij^     Zinc  chloride  melted  in  plates,  45  gms. 
Water,  25  gms. 
Potassium  iodide,  70  gms. 
Iodine,  4.25  gms. 

The  chloride  of  zinc  is  dissolved  in  warm 
distillated  water.  Then  IK  is  added  by  de- 
grees. A  yellow  precipitation  is  formed^ 
''vhich  is  dissolved  again  by  ebullition.  We 
take  the  vessel  away  from  the  fire  and  then  the 
iodine  is  added  in  agitating  until  complete  dis- 
solution. M.  Moure  has  obtained  good  results 
with  that  solution. 

M.  A.  Colin  obtained  last  year  a  complete 
cure  with  ferric  chloride. 


OF  THE  PHARYNX.  49 

In  \.\iQ  Archives  de  Laryngologie,  1896,  page 
451,  the  author  relates  the  case  as  follows: 

"I  had  used  the  officinal  solution  that  con- 
tains 26  parts  of  ferric  chloride  and  74  parts  of 
water. 

With  a  plug  of  cotton  soaked  with  that  solu- 
tion I  had  colored  the  at^  icked  part  of  the 
pharynx. 

I  saw  almost  instantaneously  all  the  mycosic 
points,  impregnated  with  the  liquid,  and  take 
hrst  its  yellcw  tint,  then  become  a  dark-mar- 
oon, the  mucous  membrane  keeping  its  normal 
tint. 

Two  days  after,  when  I  saw  the  patient,  the 
tufts  were  of  a  pure  black.  With  the  stylet  I 
found  them  of  a  hard  consistence,  and  with  the 
nasal  forct^ps,  I  extirpated  them,  one  by  one, 
without  any  difficulty. 

I  state  that  the  ferric  chloride  had  deeply- 
penetrated,  in  those  vegetations,  only  the  ex- 
tremity of  the  root  remaining  yellow,  was  vir- 
gate,  and  seen  through  the  wen.  I  could  not 
see  any  breaking.  It  seemed  that  it  had  been 
entirely  pulled  out. 

During  three  weeks  I  made  the  dressing 
every  other  day,  and  the  mycosic  points  dis- 
appeared. 


5°  HYPERKERATO-MYCOSIS 

On  the  basis  of  the  tongue,  on  the  posterior 
wall  of  the  pharynx,  that  is  to  say,  everywhere 
where  the  leptothrix  is  on  the  smooth  mucous 
membrane,  the  vegetations  had  disappeared 
after  3  or  4  dressings,  without  extirpation  It 
was  more  difficult  to  destroy  the  tufts  that 
were  in  the  crypts. 

For  a   month   and  a  half  I  saw  the  patient 
only  once  a  week.  She  had  Ipcunaris  tonsillitis 
but  the   crypts  did  not   contain  any  more  my' 
cosic  spots." 


OBSERVATION    IV. 

(Hemenway,) 

Miss  K.,  32   years  old,  came   on  the  13th  of 
April,    1 89 1,   complaining  of  a  white  stain  on 
the  left  tonsil.     The   two   tonsils  are  swollen 
and  lightly  congested,  especially  the  left  tonsil 
having  a  surrounding  form.     On  this  one  there 
are  two  white  spots,  the  larger  having  a  diam- 
eter of  two   millimetres   and  a  height  of  one 
millimetre  over  the  thick  surface  of  the  mucous 
membrane.     There   were  small   stains  on  the 
Tight  tonsil. 

The  author  made  a  diagnosis  of  tonsillary 
pharyngitis,  prescribed  a  purgation  and  gargles 
with  potassium  permanganate. 


OF  THE  PHARYNX.  5  I 

Few  days  after  the  spots  were  larger  instead 
of  having  diminished. 

The  largest  looked  like  a  mass  of  fly's  eggs, 
of  a  whitish  color. 

it  was  examined  with  the  microscope  by  the 
author  who  found  a  few  little  epithelial  cells 
and  fasces  of  small  sticks. 

It  was  not  the  diphtheria,  or  a  follicularis 
pharyngitis. 

A  local  treatment  was  applied.  Boracicacid, 
carbolic  acid,  thymol,  eucalyptol,  menthol, 
iodine,  were  successively  tried  without  suc- 
cess. 

Then  the  author  proposed  the  electro-cautery. 
The  patient  refused  and  went  away. 

The  author,  being  convinced  that  the  disease 
was  a  case  of  hyperkerato-mycosis,  had  the  pa- 
tient back  and  took  off  a  part  of  the  white  spots 
with  a  forceps. 

In  July,  Miss  K.  had  an  acute  tonsillitis,  ac- 
companied with  augment  of  the  hyperkerato- 
mycosis,  for  which  she  employed  "listerin." 

On  the  30th  of  August  inflammation  and 
swelling  had  disappeared,  everything  but  one 
white  tuft. 

M.  Hemenway  advises  the  glycerine  and  hy- 
drochloric acid  without  success. 


C2  HYPERKERATO-MYCOSIS 

On  the  17th  of  September  the  tonsils  were 
much  smaller,  each  one  having  a  white  stain, 
different  in  appearance  to  the  others. 

The  1 8th  of  September  the  patient  consulted 
a  specialist  of  Chicago,  who  treated  her  with 
electro-cautery. 

OBSERVATION    V. 

(Unpublished,  Dr.  A.  Castex.) 

Miss  X.,  young  girl  25  years  of  age,  born  in 
America,  singer,  was  always  in  good  health; no 
antecedent  diseases.  For  a  few  months  she  felt 
a  sensation  of  stitching  in  the  pharynx,  but  it 
is  not  painful.  No  trouble  for  the  degluti- 
tion. 

She  states  also  that  her  voice  is  poor  in  sing- 
ing and  tires  more  quickly  than  usually. 

With  these  subjective  symptoms  tonsillitis 
follow  each  other. 

With  an  objective  examination  we  saw  white 
spots,  surrounded,  having  the  form  of  tufts,  on 
the  liiternal  surface  of  the  two  tonsils,  a  little 
on  the  back  wall  of  the  pharynx  and  a  good 
deal  on  the  tonsil  of  Luschka. 

I  prescribed  hot  gargles,  with  aqueous  solu- 
tion of  resorcin  (1%),  and  with  the  nasal  for- 
ceps of  Duplay  I  extirpated  each  time  5  or  6  of 


" 


QF  THE  PHARYNX, 


53 


those  small  blocks  which  were  hard  and  whit- 
ish and  came  of  the  crypts  of  the  tonsils. 

For  the  lingual  tonsil  I  used  a  forceps  with  a 
particular  curve,  shorter  than  the  forceps  for 
the  polypus  of  the  larynx. 

After  ten  operations  the  parasite  disap- 
peared. 

A  few  of  the  white  spots  seemed  to  reproduce 
themselves,  but  only  in  the  beginning  of  the 
treatment. 

The  way  that  I  make  the  extirpation  is  easy 
and  without  pain. 

When  the  young  girl  was  cured  the  sensation 
•of  stitching  had  disappeared  and  the  voice  was 
as  before. 

OBSERVATION    VI. 

(Unpublished,  Dr.  A.  Castex.) 

Miss  E.  v.,  young  English  girl,  13  years  old. 
No  antecedent  diseases,  but  is  very  often  seized 
with  tonsillitis. 

The  young  girl  feels  also  a  sensation  of 
stitching  in  the  throat  and  some  trouble  for  the 
deglutition,  but  there  are  no  other  subjective 
symptoms.  On  examining  the  mouth  and  the 
pharynx  the  tonsils  are  seen  bristled  up  with 
small  white  mycosic  points. 

Nothing  on  the  basis  of  the  tongue  nor  on 
the  back  wall  of  the  pharynx. 


.il«l 


54  HYPERKERATO-MYCOSIS 

I  prescribe  hot  antiseptic  gargles  with  resor- 
cin  (ifo),  and  with  the  forceps  I  extirpate  at 
each  time  some.mycosic  points. 

These  small  white  tufts,  being  extirpated, 
have  the  form  of  tipcats,  of  nails. 

After  the  extirpation  with  the  forceps  I  had 
cauterized  with  the  gal vano -cautery  all  the 
points  of  implantation.  The  tufts  had  not  com- 
pletely disappeared  at  the  eighth  time. 


M.  A.  Castex  has  seen  lately  four  other  cases, 
six  in  all  (two  children,  a  young  man,  a  woman 
of  40  years  old,  and  two  young  girls).  The  dis- 
ease was  always  characterized  by  a  trouble  or 
a  sensation  of  stitching  in  the  pharynx.  The 
recovery  is  difficult. 


OBSERVATION  VII. 


(Homer  M.  Thomas,   in  Med.  Rec,  N.  K,  6th 
Jan.,  1894,  and  Dr.  Fraenkel,  of  Berlin.) 

The  history  of  the  case  as  given  by  the  pa- 
tient, Mrs.  C.  B.,  is  that  during  August,  1892, 
she  suffered  from  a  slight  irritation  of  the 
pharynx. 

There  were  white  spots  on  the  tonsils  which 
disappearedaftera  few  days  but  returned  within 
a  couple  of  weeks.  . » 


OF  THE  PHARYNX.  55 

The  physicians  consulted  called  the  trouble 
a  mushroom  growth,  and  said  it  would  require 
two  or  three  treatments  a  week  for  some  three 
months  to  effect  a  cure. 

The  trea^  nent  consisted  of  a  forcible  remov- 
al of  the  exudate  by  means  of  forceps. 

This  method  of  treatment  was  attended  with 
severe  pain  and  proved  unsatisfactory. 

The  patient,  becoming  discouraged,  consulted 
Dr.  Fraenkel  of  the  Berlin  University  in  No- 
vember. 

At  that  time  he  found  spots  covering  the 
tonsils  and  extending  to  the  root  of  the  tongue. 
His  treatment  consisted  of  swabbing  the 
throat  two  or  three  times  a  week  with  a  five  per 
cent,  solution  of  carbolic  acid,  and  he  recom- 
mended that  the  throat  be  gargled  two  or  three 
times  a  day  with  pure  brandy. 

Under  this  treatment  the  throat  seemed  to 
grow  somew^hat  better,  but  stil.  le  disease  was 
not  wholly  eradicated. 

Having  been  called  to  this  city  (Chicago), 
Mrs.  B.  came  under  my  care,  January  4,  1893, 
at  which  time  pharyngo-mycosic  deposit  was 
very  extensive  upon  the  posterior  pillars  of  the 
fauces  and  invaded  the  root  of  the  tongue,  al- 
most  completely  coveting  it,  and  there    were 


5^  HYPERKERATO-MYCOSIS 

extensive  deposits  upon  the  tonsillar  sub- 
stance. 

After  having  confirmed  the  diagnosis  as 
made  by  Dr.  Fraenkel  through  microscopic  ex- 
amination of  the  deposit,  I  advised  treatment, 
to  consist  of  the  rough  application  of  the  gal- 
vano-cautery. 

The  electrode  selected  was  one  made  for  me 
in  Vienna,  and  consisted  of  a  very  fine  elon- 
gated platinum  point  which  enabled  me  to 
introduce  it  directly  into  each  one  of  the 
crypts  of  the  tonsil  affected  by  the  disease,  and 
also  to  eradicate  the  punctated  growths  at  the 
base  of  the  tongue. 

At  first  only  three  or  four  punctures  were 
made  at  each  treatment,  the  treatments  occur- 
ring three  times  a  week.  As  the  patient  grew 
more  tolerant  of  the  irritations  following  the 
use  of  the  galvano-cautery,  the  number  of 
punctures  per  treatment  were  increased  until  I 
frequently  applied  the  cautery  to  eight  or  ten 
of  the  mycotic  masses  at  each  treatment. 

The  effect  secured  has  been  satisfactory  to 
the  extent  that  the  disease  has  not  reappeared 
in  any  of  the  foci  cauterized. 


^' 


OF  THE  PH/  RYNX. 


57 


CONCLUSIONS. 

^^ Hyper kerato-mycosis  of  the  pharynx^'  was 
observed  and  studied  for  the  first  time  in  1873, 
by  B.  Fraenkel,  of  Berlin. 

Very  few  observations  were  mr^e  until  1888, 
when  the  disease  being  better  known  was  noted 
more  often. 

This  disease  is  characterized  by  the  appear- 
ance of  small  white  points,  looking  like  mush- 
rooms, or  "Capuchin's  bearb,"  or  the  heads  of 
nails,  which  come  on  the  tonsils,  the  base  of  the 
tongue,  and  sometimes  on  the  back  wall  of  the 
pharynx,  and  the  epiglottis,  etc. 

Generally  these  small  white  points  contain 
various  microbes,  such  as  leptothrix  buccalis, 
nigrities  linguae,  o'ldium  albicans,  bacillus  fas- 
ciculatus,  aspergillus,  fumigatus,  etc.,  in  a 
corneous  tissue. 

These  white  hyperkerato-mycosic  points  are 
very  difficult  to  remove;  often  reappearing 
after  twenty-four  hours. 

The  subjective  symptoms  are  not  always  pres- 
ent; but  when  they  are  present,  they  are  mani- 
fested by  a  tickling  and  sometimes  a  pricking 


gS  HVPERKERATO-MYCOSIS 

sensation,  accompanied  with  uneasiness  and  a 
pain  when  swallowing. 

The  etiology  is  very  obscure. 

The  disease  is  more  prevalent  to  invalids, 
and  particularly  to  those  having  already  had 
inflammations  of  the  throat. 

This  disease  is  most  often  found  in  women, 
between  the  ages  of  15  and  30  years. 

The  diagnosis  is  simple;  the  symptoms  being 
both  chronic  and  benignant,  in  which  this  dis^ 
ease   differs   from   the   other  diseases   of    the 

throat. 

Prognosis  is  benignant. 

The  treatment  consists  of  picking  off  the 
hyperkerato-mycosic  points,  followed  by  cau- 
tery; at  the  same  time,  gargling  with  hot  solu- 
tion of  resorcin  (i  %.) 


t 


f  ► 


\ 


OF   THE   PHARYNX. 


59 


f    » 


4 


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Creswell-Baber:  British  Medical  Journal, 
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6o  HYPERKF.RATO-MYCOSIS 

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4S5. 

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Royet:  Echo  medical  de  I^yon,  August  15, 1896. 


! 


I 


OF  THE  I'HARYNX.  6l 

Ruault:  Annates  de  Laryngologie,  Rhinologie 
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Sokolowski:  Journal  of  Laryng.,    February, 

1892. 

Vanderpool:  New  York  If  d.  Journ.,  Febru- 
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Webster:  Journal  of  Laryngo.,  etc.,  Feb- 
ruary, 1892. 


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